Healthcare Provider Details

I. General information

NPI: 1053798488
Provider Name (Legal Business Name): MONICA KHLEANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WESTBROOK AVE
RICHMOND VA
23227-3337
US

IV. Provider business mailing address

14031 PLANTERS WALK DR
MIDLOTHIAN VA
23113-3776
US

V. Phone/Fax

Practice location:
  • Phone: 703-585-5178
  • Fax:
Mailing address:
  • Phone: 703-585-5178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131001084
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: